Provider Demographics
NPI:1881829240
Name:MARTIN, JEREMY M
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4767 DRANE FIELD RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-1220
Mailing Address - Country:US
Mailing Address - Phone:863-816-5858
Mailing Address - Fax:863-816-5837
Practice Address - Street 1:4767 DRANE FIELD RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-1220
Practice Address - Country:US
Practice Address - Phone:863-816-5858
Practice Address - Fax:863-816-5837
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic